Dallas RAC Information

Defending Texas Providers Against Overpayment Claims

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manajemen keperawatanDo you provide health care services to Medicare recipients in Dallas, Fort Worth or elsewhere in Texas? Are you concerned about whether you are prepared for the possibility that you will be audited under the federal government's newly expanded recovery audit contractor (RAC) program?

At the law firm of Wachler & Associates, P.C. , we have developed an in-depth familiarity and understanding of the RAC audit process through our representation of clients facing audits in states that participated in the program's demonstration phase. We have also carefully studied recent changes to the program that are being implemented during its nationwide rollout.

If you are facing a RAC audit, interested in appealing the results of a RAC audit or concerned about any other aspects of the program, don't hesitate to contact us to discuss your concerns with one of our experienced health law attorneys .

Helping Hospitals and Other Providers Deal With RAC Audits

As of Mar. 1, 2009, medical providers in Dallas-Fort Worth and in many other areas are subject to audits of their billing and medical records by private RAC companies that have been chosen by the Centers for Medicare and Medicaid Services (CMS). In Region C, including Texas, the RAC is Connolly Consulting Associates, Inc.

All of the following types of providers can, to the extent that they provide billed medical services to Medicare recipients, be audited:

  • Hospitals and health systems
  • Hospice and home health agency (HHA) providers
  • Physicians and physician groups
  • Ambulatory surgery centers (ASCs)
  • Radiology providers and independent diagnostic testing facilities (IDTFs)
  • Skilled nursing facilities (SNFs)
  • Durable medical equipment (DME) providers

Providers should also be prepared for Zone Program Integrity Contractor (ZPIC) audits. ZPICs are CMS contractors that look for overpayments and potential fraud. For these audits, each state has been assigned to a different contractor. Texas is located in Zone 4 for ZPIC audits, with Health Integrity, LLC as its contractor.

Asserting Your Interests Throughout Audits and Appeals

One controversial aspect of the RAC audit process is that, when they identify alleged CMS overpayments to medical providers (and underpayments, but those are a small minority of cases), RACs are paid a contingency fee — a percentage of the amount of money recovered. This gives these private companies a clear profit motive in how they carry out their audits.

Thankfully, there is an extensive, five-step appeals process by which providers can pursue reversals or reductions of payment demands that have been made to them as a result of the RAC audit process.

Our lawyers are experienced at pursuing administrative appeals and, specifically, at pursuing RAC appeals. Our nationwide practice has enabled us to track the progress of the program during the demonstration period, and we are now able to offer that experience to clients in the Dallas-Fort Worth Metroplex and elsewhere in Texas who are newly subject to the program.

For help dealing with a RAC audit, ZPIC audit, another Medicare audit or any type of medical payor audit , contact us at Wachler & Associates, P.C.

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